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Erin C. Wilson transnationalstudy erin.wilson@sfdph

Beyond Gender Affirmation – Addressing root causes of HIV risk and disease among trans women, data from the Trans*National study. Erin C. Wilson www.transnationalstudy.org erin.wilson@sfdph.org San Francisco Department of Public Health. Share your thoughts on this presentation with #IAS2019.

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Erin C. Wilson transnationalstudy erin.wilson@sfdph

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  1. Beyond Gender Affirmation – Addressing root causes of HIV risk and disease among trans women, data from the Trans*National study Erin C. Wilson www.transnationalstudy.org erin.wilson@sfdph.org San Francisco Department of Public Health Share your thoughts on this presentation with #IAS2019

  2. I have no conflicts of interest.

  3. Trans*National Study

  4. Trans*National AIMS

  5. Nanjing, China: Survey (250 participants) San Francisco: Survey (629 participants) and 18-month cohort study (429 participants) Windhoek, Namibia: Qualitative interviews (25 participants) São Paulo, Brazil: 18-month cohort study (583 participants)

  6. HIV prevalence in context of gender affirming care access Castro Mission Health Services – Esperanza clinic & Dimensions clinic for youth Lyon Martin trans health clinic SF Community Health Center + Private Providers at Kaiser, UCSF Mt Zion, UCSF Gender clinic for adolescents and youth, and more! 1993 - Trans Tues clinic opens

  7. Trans*National 6 mos assessment, N=270 Is surgery associated with less mental health distress and/or substance use?

  8. Of those who have not had any procedure (n=109) • 15% do not want any procedures • 33% cannot pay for procedures • 10% report unstable housing as a barrier to surgeries

  9. Considerable mental distress

  10. Significant substance use

  11. Results: Utilization of gender affirming procedures and surgery was not associated with less… • Mental health distress • Substance use

  12. Persistently high HIV incidence among trans women, San Francisco • Erin C. Wilson1, Caitlin Turner1, Jess Lin1, Maria Amelia Veras2, Hongjing Yan3, and Willi McFarland1 • Center for Public Health Research, San Francisco Department of Public Health (San Francisco, CA) • Santa Casa University, Sao Paulo, Brazil, 3. Jiangsu Center for Disease Control and Prevention, Nanjing, China • RESULTS • A total of 429 HIV-uninfected trans women were enrolled in the cohort; 412 had at least one follow-up visit and were included in the present analysis (96% retention). • Eight seroconversions were observed for a preliminary HIV incidence of 1.4 per 100 person-years (PY) (95% CI: 0.60-2.76). • Preliminary incidence was very high among younger trans women ages 18-24 years (3.88 per 100 PY). • All seroconversions were among trans women of color, with the majority being Latinas (incidence 2.76 per 100 PY). • One participant who seroconverted was previously on PrEP.

  13. If you could change one thing for trans women in the Bay Area, what would it be?

  14. What next • Gender affirming services are a necessary human right for trans women • Gender affirming services alone are not sufficient for reducing HIV risk among trans women • The final frontier for addressing the HIV risk and care needs of trans women will require addressing big structural factors like stigma, discrimination, violence and housing in health care and society

  15. Thank you! • Trans*National research team: Sofia Lynn, Theo Beltran, Victory Le, Karen Aguilar, Corey Drew, Willi McFarland, Henry Fisher Raymond, Oriana Saportas, Marla Fisher, Andres Pomart, Rafael Gonzalez, Cat Kazbour, Caitlin Turner, Jess Lin • Trans*National participants

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